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Sunday, 25 March 2012

EWTR - Sleepy Tired Doctors are Unsafe Doctors

A major newspaper ran a campaign last year in association with one of the surgical royal colleges against the
European Working Time Regulation for doctors especially for surgeons. I am
finding it uneasy that we seem to have lost balance on this issue and chosen to
take the campaign mode. We learn that the Government could ask for an
exemption from EWTR for British doctors. Having done training posts in the
pre-EWTD era and regularly worked more than 80 hour weeks in surgery, I welcome
the European Working Time Regulation especially for doctors in training; but it
not just a matter of opinion.

Acute sleep deprivation has been shown to result in more errors, longer time to
complete tasks, slower
reaction times resulting in a deterioration in clinical performance. This is the case in both In simulated and real time environment. There are important consequences for chronic sleep
deprivation as well. The issue is not just about the duration of sleep but also
the importance of quality of sleep, which is indirectly reflected in some of the
rules of the EWTR regarding continuous uninterrupted rest periods. Healthcare
claims to be learning from the airline industry, the airline industry recognised
the issue of working hours and rest and has very strict rules for the pilots
regarding flying hours; it is well known that scheduled commercial airlines rank
very high in safety.

Since the gradual implementation of the working time
directive, now a regulation, this country has not seen any objective worsening
of clinical standards such as mortality or complications; in fact most
parameters have shown an improvement in standards of care, obviously there is no
implication of cause and effect here. However, surveys showing perception that
patient care has possibly become unsafe are not really borne out by objective
evidence; as a profession based on science we must be aware of both the power
and limitations that perceptions can have. Further, I am not aware of even a
single consultant level doctor appointed in recent times who has stopped being a
consultant and gone back to training due to any recognition that the EWTD
allowed poor training.

If indeed, as a country we
wanted to act on a survey perception that EWTR is affecting training, instead of
putting patients at potential risk by asking doctors to work longer hours, the
powers in charge of training should have addressed the issue by prolonging the
period required to complete the training. Part-time trainees do this all the
time while providing equal quality of care and with the changing gender profile
of the medical profession this becomes even more relevant.

Europeans, in consideration of a better quality of life
have taken a societal direction to work lesser hours and for British doctors to
some how claim that we are very different from the society we live in, is an
attitude incompatible with modern life. Doctors are not super human, though it
may seem some of us ardently wish to be so.

There is no scientific, operational or societal
reasons to oppose the EWTR. I think it is time to recognise this before the
society begins to wonder if there were considerations other than these in the
medical profession's decision making; that would damage the image of the
profession. There have also been recent suggestions that we can ignore the law,
such a thinking does not bode well for a profession held in high esteem by the
public. The issue is about safer healthcare, longer duration of working which is
highly likely to result in sleep deprivation impacts adversely on safety.

If I
had the opportunity to choose my doctor I would obviously opt for a well
qualified and experienced one who is not tired, I am not sure anyone would
choose otherwise. Is it unreasonable to ask the government to ensure the same
for me through the NHS?